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Contract Type FiledJune 28th, 2021 JurisdictionDELTA DENTAL OF NEW YORK, INC. DELTA DENTAL PPO DENTAL SERVICE CONTRACT FOR EXPERIENCE RATED GROUPS TABLE OF CONTENTS PAGE ARTICLE I Definitions 1 ARTICLE II Enrollment 6 ARTICLE III Entitlement to Services 7 ARTICLE IV Administration of Claims for Services 7 ARTICLE V Coordination of Benefits 9 ARTICLE VI Payment for Covered Services 11 ARTICLE VII Exclusions and Limitations 12 ARTICLE VIII General Provisions 12 ARTICLE IX Reports and Records and Inspection Thereof 17 ARTICLE X Contract Renewal, Modification and Termination 18 ARTICLE XI Extent of Entire Contract 20 ARTICLE XII Cancellation of Existing Contracts 20 Schedule A Appendix A Addendum